Society for Clinical Vascular Surgery

SCVS Home SCVS Home Past & Future Symposia Past & Future Symposia


Facebook   Instagram   Twitter   Youtube

Back to 2025 Display Posters

Medical Student
Yiming Zhang, M.D., Tammy Nguyen, MD, PhD.
UMass Chan Medical School, Worcester, MA, USA.

OBJECTIVES: Poorly controlled diabetics (PC-diabetics) may require a major lower extremity amputation (LEA) due to foot ulcer infection. Social determinants of health (SDoH) have been shown to play an important role in health outcome. However, specific SDoH domains that impact PC-diabetics are unclear. This study aims to utilize Epic Cosmos, an electronic medical record database, to identify the specific social risk factors for PC-diabetics with/without LEA. METHODS: Epic Cosmos is a HIPAA-compliant data platform that contains longitudinal records of 270 million patients. PC-diabetics were queried based on A1C test ≥ 6.5% and non-diabetic or controlled diabetic patients were identified as A1C test < 6.5% (N/C-diabetic) from 2014 to 2018. Within these two cohorts, LEA within 5 years of the A1C test were identified through CPT codes (27590/27591/27592/27594/27880/27881/27882/27884). SDoH diagnoses were identified through ICD-10-CM Z-codes (Z55 - Z75) in both PC-diabetic and N/C-diabetic cohorts with/without LEA. Demographic characteristics were also collected to characterize group-specific SDoH risks. RESULTS: We identified 5,268,010 PC-diabetic patients (71.90% white, 19.61% black) and 11,369,542 N/C-diabetic patients (73.19% white, 17.25% black). Of the PC-diabetic cohort, 21,530 had LEA (0.41% total, 70.54% white, 25.77% black). The N/C-diabetic cohort had 5,996 LEA (0.053% total, 69.05% white, 28.95% black). Of the PC-diabetics with LEA, 27.94% had at least 1 SDoH diagnosis, in contrast to 11.68% of the PC-diabetics without LEA or 11.77% of N/C-diabetics. PC-diabetics with LEA are 3.12 times more likely to have problems related to housing/economic circumstances (Z59) and 2.59 times more likely to have problems related to lifestyle (Z72) when compared to PC-diabetics without LEA. Race/ethnicity analysis among PC-diabetic LEA did not reveal significant differences between patients who identify as white/Caucasian and black/African American. However, African American PC-diabetics have higher baseline rates of SDoH diagnoses (14.50%) when compared to white/Caucasian PC-diabetics (11.48%). CONCLUSIONS:
Our analysis demonstrates the utility of Epic Cosmos to identify SDoH risk factors for PC-diabetics with/without LEA. We found higher SDoH rates for housing/economic and lifestyle challenges in PC-diabetics with LEA compared to no LEA. Future analysis of the ICD-10-CM Z-subcodes can provide further directions to address specific SDoH risk factors.
Back to 2025 Display Posters